Scaling Practice Management by Talkie.ai

When you're growing a practice, it's easy to let the numbers start making your decisions for you. Dr. Louis Gilbert refuses to.

Dr. Louis Gilbert, founder and CEO of Cornerstone MD, is building a multi-location family medicine group across Houston and Pasadena, Texas - with a goal of opening a new clinic every year. He joins Jakub Grajcar to talk leadership, integrity, and growing a practice without losing sight of the people it serves. He also talks about his experience as a client of Talkie.ai, implementing an AI receptionist at his practice.

We dig into:

🏥 Dr. Gilbert's #1 tip for growing a practice - grow people before you grow locations, because culture and problem-solvers are what actually scale
🚶 The "Walk with a Doc" program - how a monthly community walk turned patients into family and grew the practice
🌱 "Grow where you're planted" - why the Pasadena and Houston clinics run differently, and how one core standard still holds both together
⚖️ People before profits - what integrity looks like in the everyday decisions practice leaders actually face
📞 Covering the calls you're missing - how Dr. Gilbert kept his front desk and let Talkie AI triage the overflow instead of hiring a 20-person call center
👥 The 3 I's of hiring (via Warren Buffett) - intelligence, initiative, and integrity, and why initiative is the hardest to spot

Resources mentioned:

👤 Guest: Dr. Louis Gilbert
LinkedIn: https://www.linkedin.com/in/louis-gilbert-26b646184/
Instagram: https://www.instagram.com/_drlouisgilbert_/

🏥 Cornerstone MD: https://cornerstonemd.health
Lumé Haus (medical spa): https://www.lumehaus.health/
myWelli (healthcare app in development): https://www.mywelli.health/

🏛️ Texas Medical Association - supported the launch of Walk with a Doc

🧠 Also mentioned
Warren Buffett's "three I's" hiring framework - intelligence, initiative, integrity

🎥 See how Talkie.ai works - AI medical receptionist demo: https://www.youtube.com/watch?v=oOiJ3ITTrLY&list=PLLjcCBHYN2KoBqm-Dx-8lIwWLuU-CHXSg

Most practices chase marketing tactics - SEO, ads, podcasts, webinars - before they ever settle on a strategy. Saul Marquez calls that the treadmill, and he says it's where most growth quietly dies.

Saul spent two decades in medical device sales, left a VP role, and bootstrapped Outcomes Rocket into a global healthcare marketing agency - now 1,900+ interviews deep with founders, CEOs, and clinicians. He joins Jakub to lay out the exact framework he uses to help healthcare companies grow.

We dig into:

🏥 Saul's #1 tip for growing a practice - keep your team as close to patients as possible, and let technology carry the repetitive load
🧭 The 3D model - Discover, Define, Deliver - and why strategy has to come before any tactic
🔁 The "treadmill" trap - how to tell real progress from busywork
📊 Why only 28% of healthcare marketers document their strategy - and why the other 72% are your opportunity
🧱 Owned, earned, paid - the order to build your marketing in, and why paid comes last
🎯 The "three uniques" - the questions that force out what your practice does that nobody can match
🤖 Why every practice needs an AI strategy before vetting vendors - "if you don't have a plan, you become part of somebody else's plan"

Resources mentioned:

👤 Guest: Saul Marquez
LinkedIn: https://www.linkedin.com/in/saulmarquez1/
Outcomes Rocket: https://outcomesrocket.com

🎙️ Podcasts
Healthcare Marketing Executive (Saul's podcast, Jakub was a guest): https://www.youtube.com/watch?v=B6-SxLblM5o
Outcomes Rocket (Saul's original podcast, 1,900+ interviews): https://www.outcomesrocket.com/podcast

🏢 People & companies mentioned
Pat Williams, iScribe Health

🧠 Frameworks & references
The 3D model: Discover, Define, Deliver
"Tactics are the noise you hear before the war is lost" - Sun Tzu, The Art of War
Aristotle's appeals of persuasion - ethos, pathos, logos
McKinsey - only 28% of healthcare marketers document their strategy
"Positive discontent"

🎙️ Related SPM episode
Evan Steele of rater8 on reputation management (ep. 9): https://open.spotify.com/episode/5detjLcslSPFokVcObgkcs?si=f80bfbcb401b4076

🎥 See how Talkie.ai works - AI medical receptionist demo: https://www.youtube.com/watch?v=oOiJ3ITTrLY&list=PLLjcCBHYN2KoBqm-Dx-8lIwWLuU-CHXSg

Can a nurse practitioner build more than a one-person practice that just replaces a salary? Amanda Guarniere says yes - and most NPs never find out because nobody shows them what's possible.

Amanda is a Yale-educated NP with 15 years of clinical experience, VP of Enterprise Partnerships at Guardian MD, and the founder of The Resume RX. She also runs her own wellness and aesthetics practice - so she sees both the clinical and the business side.

She joins Jakub Grajcar to break down how NPs can legally own, run, and scale a practice. We dig into:

🏥 Amanda's #1 tip for growing a practice - know exactly who your future patient is before you build, then create messaging that attracts them and repels everyone else
🧠 Why most NPs never scale past replacing their own salary - and the mindset shift that changes it
⚖️ The compliance buckets every NP must understand - practice ownership vs. medical oversight, and why they're different in every state
📍 State-by-state reality check - from fully independent states to Texas, Georgia, and the rare in-person supervision rules
🚨 What actually triggers an audit (usually a complaint) - and why so much runs "on your honor" until it doesn't
👥 The real signal you're ready to hire - a full schedule and a 2-3 week waitlist, not just the wish to grow
🔮 Where NP regulations are heading post-COVID - and why it comes down to lobbying power, not logic

Resources mentioned:

👤 Guest: Amanda Guarniere, NP
LinkedIn: https://www.linkedin.com/in/aguarniere/
Guardian MD - remote medical directors & compliance infrastructure: https://guardianmedicaldirection.com/
The Resume RX - career resource for nurses & NPs: https://www.theresumerx.com/

📚 Books
The Big Leap by Gay Hendricks
Building a StoryBrand by Donald Miller
Vivid Vision by Cameron Herold

🧠 Frameworks mentioned
EOS (Entrepreneurial Operating System) - the "seats" concept: delivery, growth, operations
"Glass balls vs. plastic balls" - priority triage

🎙️ Related episode
Cornelius Schmahl on scaling (ep. 28): https://www.youtube.com/watch?v=H2jC5oyfrhg&list=PLLjcCBHYN2KoABUtTOYaMLQMARJjb_8zS&index=1&pp=iAQBsAgC

🎥 See how Talkie.ai works - AI medical receptionist demo: https://www.youtube.com/watch?v=oOiJ3ITTrLY&list=PLLjcCBHYN2KoBqm-Dx-8lIwWLuU-CHXSg

What does scaling Uber across 300 cities have to do with running a medical practice? More than you'd think.

Cornelius Schmahl spent five years at Uber launching the service across Europe and Africa, finishing as interim CEO of a national branch where he led a $3.7 billion merger. He went on to become COO of a telemedicine company, made 100+ angel investments, and now coaches founders of high-growth companies.

He joins Jakub Grajcar to translate startup scaling lessons into something any practice owner can use.

We dig into:

🏥 Cornelius's #1 tip for growing a practice - treat it like a business, not a place where you "doctor people"
🎯 The dollar-amount rule that lets your team make decisions without you - and how to test it safely
📚 Why building a shared knowledge base (and rewarding people for it) is how Uber scaled to hundreds of new cities
📞 The first thing to automate in your operations - and why it gives you visibility you never had
🧠 Fixed vs. growth mindset - why doctors get stuck on "I'm the hero" and how to let go of control
📣 The most overlooked lever in healthcare - and how to catch up on it

Resources mentioned:

👤 Guest: Cornelius Schmahl
LinkedIn: https://www.linkedin.com/in/cornelius-peter-schmahl/
Coaching: https://unicorn.coach

📚 Books
Thinking in Systems by Donella Meadows
Mindset by Carol Dweck
They Ask You Answer by Marcus Sheridan
Building a StoryBrand by Donald Miller

🧠 Also mentioned
Ikigai (Japanese purpose framework)
The EOS "seats" concept for delegating roles in a business

🎥 See how Talkie.ai works - AI medical receptionist demo: https://www.youtube.com/watch?v=oOiJ3ITTrLY&list=PLLjcCBHYN2KoBqm-Dx-8lIwWLuU-CHXSg

What if you could design a primary care practice from a blank canvas - AI at the front door, overhead at half the industry average, and every minute saved reinvested in the doctor-patient relationship?

Dr. Zeshan Rajput is doing it. A physician, clinical informaticist, and MBA with 15+ years across EHR implementations and federal health IT strategy, he's now building New Hope Primary Care in Columbia, Maryland from the ground up.

We dig into:

🏥 Dr. Rajput's #1 tip for growing a practice - design every patient touchpoint the way Disney would, and ask whether you'd want to be your own customer

🤖 The four-bucket framework for deciding what AI should and shouldn't touch - human only, human-first/AI review, AI-first/human review, and AI only

⚠️ Printers, passwords, policies - the three failure modes of every tech rollout, and why policy is the one most practices get wrong

📊 The #1 reason healthcare tech implementations underdeliver - and it's not the go-live, it's the optimization window that follows

💰 Targeting 25-35% overhead in a world where most practices run 65-80% - and the provider-only staffing matrix behind it

🔥 The hot take that might get him in trouble - which subspecialties of medicine could become AI-first first

Resources mentioned:

👤 Guest: Dr. Zeshan Rajput, MD
LinkedIn: https://www.linkedin.com/in/zrajput/
🏥 New Hope Primary Care: https://newhopeprimarycare.com/?utm_campaign=talkie-podcast

📚 Books mentioned:
If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently - Fred Lee

🧠 Frameworks mentioned:
The 4-bucket framework for AI vs human work - credit to Dr. Mark Kramer

📝 Also referenced:
Talkie blog post - How Much Do Missed Calls Cost a Medical Practice? (with embedded calculator): https://talkie.ai/blog/how-much-do-missed-calls-cost-medical-practice/

🎥 See how Talkie.ai works - AI medical receptionist demo: https://www.youtube.com/watch?v=oOiJ3ITTrLY&list=PLLjcCBHYN2KoBqm-Dx-8lIwWLuU-CHXSg

Most practice managers got promoted into leadership without anyone teaching them how to lead. The result is real, daily knowledge gaps that quietly cost practices in turnover, denied claims, and legal exposure.

Mike Lyons, SPHR - founder of Seasoned Advice and host of Eye Care Leadership Live - spent nearly six years building the HR function at Austin Retina Associates before going independent. He joins Jakub Grajcar to break down how to hire, manage, and develop the leaders who actually scale a practice.

We dig into:

🏥 Mike's #1 tip - why you cannot scale a practice without great managers
🤝 Hiring for people skills - what to look for and why promoting from within wins
🗓️ Managing the manager - the weekly cadence and skip-level habit that keeps it accountable
🙏 Gratitude as the ""Swiss army knife of leadership"" - and the two-part praise structure that lands
🔪 Sharpening the knife - why stepping back, delegating, and pouring into others is how managers actually create more time
📝 Documenting performance - kinder to the employee, and your best legal protection
📚 The books Mike recommends most

Resources mentioned:

👤 Guest: Mike Lyons, SPHR
LinkedIn: https://www.linkedin.com/in/mikelyonshr/
Website - Seasoned Advice: https://seasoned-advice.com
🎙️ Podcast - Eye Care Leadership Live (for ophthalmology practice managers and leaders)
YouTube: https://www.youtube.com/playlist?list=PLIW9O_gj4Ew_9I2ENW4VtjYT6vb80PG3m
Spotify: https://open.spotify.com/show/3ORgeP9UqtEcEco3lEQaaS

📚 Books mentioned

The Advantage - Patrick Lencioni
The Ideal Team Player - Patrick Lencioni
The Energy Bus - Jon Gordon
Change Your Brain, Change Your Life - Dr. Daniel Amen
The 7 Habits of Highly Effective People - Stephen Covey

🎤 Also mentioned

Toastmasters International - https://www.toastmasters.org (both Mike and Jakub credit Toastmasters as foundational leadership development)
Jacqueline Waterhouse, COT - prior podcast guest who connected Jakub and Mike - watch Jacqueline's episode: https://www.youtube.com/watch?v=qiuFJRnG9Lk

🎥 See how Talkie.ai works - AI medical receptionist demo: https://www.youtube.com/watch?v=oOiJ3ITTrLY&list=PLLjcCBHYN2KoBqm-Dx-8lIwWLuU-CHXSg

Is your practice website quietly setting up the next HIPAA lawsuit - and is your marketing message actually landing with patients who don't yet know they need you?

Tim Bouchard, CEO of Buffalo-based agency Luminus and host of the Healthcare Marketing Edge podcast, joins Jakub to share 20+ years of healthcare marketing lessons. From building patient-centric brand messages to fixing the analytics setup that's quietly exposing practices to legal risk, Tim breaks down what every practice manager should be auditing right now.

We dig into:

🏥 Tim's #1 tip for growing a practice - why every message should start with the patient's outcome, not your tech or certifications
🦵 The "knee replacement test" - how to write top-of-funnel copy that reaches patients who don't yet know they need you
⚖️ The HIPAA trap in Google Analytics - why CCPA and Colorado's CPA make standard tracking a legal risk regardless of your state
🔧 The Matomo workaround - how to run analytics, Meta ads, and email lists without exposing PHI
🌱 The community advantage - why small practices can out-brand PE-backed competitors with grassroots presence
🖥️ The biggest medical website mistake - sticky headers, persistent CTAs, and a homepage "sandwich" that reduces signup friction

Resources mentioned:
👤 Guest: Tim Bouchard
LinkedIn: https://www.linkedin.com/in/timbouchard/
Luminus Agency: https://luminus.agency/?utm_campaign=talkie-podcast

📋 Free download
Luminus Healthcare Website Compliance Guide: https://luminus.agency/healthcare-website-compliance-guide/?utm_campaign=talkie-podcast

🎙️ Tim's podcast: Healthcare Marketing Edge: https://luminus.agency/healthcare-marketing-edge-podcast/?utm_campaign=talkie-podcast
⭐ Recommended episodes:
→ Social Media Secrets for Authentic Patient Connection w/ Amanda Clark @ Atria Social: https://www.youtube.com/watch?v=UPa0Gs84KT0
→ Aligning Marketing and Operations for Sustainable Healthcare Growth w/ Michelle Hart @ BostonSight: https://www.youtube.com/watch?v=frJui5Fv45s

📊 Tools
Matomo (HIPAA-compliant analytics alternative to Google Analytics): https://matomo.org

📺 Other references
Jakub's favorite horror podcast - The Magnus Archives: https://www.youtube.com/watch?v=AdiUHYacaRI&list=PLqwvYKgb9yRaxgDWwoMk6RFDmdvqxghqy
Dark Side Off-Road (Tim's YouTube channel): https://www.youtube.com/c/darksideoffroad
The Story Till Now (off-roading YouTube channel): https://www.youtube.com/c/thestorytillnow

🎥 See how Talkie.ai works - AI medical receptionist demo: https://www.youtube.com/watch?v=oOiJ3ITTrLY&list=PLLjcCBHYN2KoBqm-Dx-8lIwWLuU-CHXSg

What does it actually look like when a practice puts culture first - not as a slogan, but as an operating system?

Dr. Joy Evers - board-certified emergency physician, CEO and founder of Healthtopia Clinics, and host of the Your Doctor Wants to Quit podcast - joins Jakub Grajcar to share how she built a four-location integrative primary care practice serving 35,000 patients in Southern California.

From same-day walk-ins to real-time curbside consults between conventional and naturopathic providers, Dr. Joy breaks down what makes Healthtopia's model work - and why it starts with how leaders show up every day.

We dig into:

🏥 Dr. Joy's #1 tip for growing a healthcare practice - why positive culture is the foundation everything else is built on
🧠 What self-reflection and daily writing practice have to do with being a better leader
👩‍⚕️ How Healthtopia blends conventional medicine with integrative care under one roof - and why that model scales
📋 The scheduling structure that makes same-day appointments and walk-ins possible (20- and 40-minute slots with built-in buffer)
🤝 How real-time curbside consults and a provider curriculum make team-based care actually work
💊 Why Dr. Joy chose insurance-based care over direct primary care - and the accessibility trade-offs involved

Resources mentioned:

👤 Guest: Dr. Joy Evers, MD
LI: https://www.linkedin.com/in/joy-evers
IG: https://www.instagram.com/doctorjoymd/

🏥 Healthtopia Clinics: https://healthtopiaclinics.com/

🎙️ Podcast: Your Doctor Wants to Quit
Apple: https://podcasts.apple.com/us/podcast/your-doctor-wants-to-quit/id1799382185
Spotify: https://open.spotify.com/show/6lEmwFrsY94K9436zLOKG9
YouTube: https://www.youtube.com/channel/UCH8eEFDbJzYWqFzHmzAJm5A
⭐ Recommended episode: "Doctor Doctor" - featuring Dr. Alyssa Burnham & Dr. Michael Turner: https://open.spotify.com/episode/3198m5k6zv16VvHaOAM8SE

🎥 See how Talkie.ai works - AI medical receptionist demo: https://www.youtube.com/watch?v=oOiJ3ITTrLY&list=PLLjcCBHYN2KoBqm-Dx-8lIwWLuU-CHXSg

Most practices know they should be doing more with technology. Fewer have actually built it out.

Dr. Elizabeth Edens - Founder of Health Meets Wellness and Medical Director at TouchCare Method - has. She joins Jakub to walk through what a fully digitized patient journey actually looks like in practice: a custom mobile app, an AI health coach, wearable integrations, and touchpoints that keep patients engaged between visits.

Dr. Edens' specialty is weight management. The lessons apply to anyone trying to introduce software, AI, or remote monitoring into their patient experience.

We discuss:

🏥 Dr. Edens' #1 tip for growing a healthcare practice - exploring how the energy of leadership sets the tone for every patient interaction
⏳ The most overlooked moments in patient care - and how to turn waiting room time into a win for your brand
✅ Why checklists aren't just for surgery - and how start-of-day prep shapes the entire practice ethos
📱 How a custom mobile app changed the way Dr. Edens manages patient care between visits
⚖️ Balancing high demand with longer, more intentional visits - and why going deeper can actually make follow-up smoother
💉 GLP-1 medications: what patients get wrong, what's missing from the media coverage, and what proper oversight looks like
🥦 The next frontier in weight management - addressing ultra-processed food
🤖 Lessons from rolling out an AI health coach adoption lesson
🔧 Build vs. buy: Dr. Edens' advice on white-labeling an existing medical app vs. building from scratch

Resources mentioned:

👤 Guest: Dr. Elizabeth Edens
LinkedIn: https://www.linkedin.com/in/elizabeth-edens-md-286a09154/
Health Meets Wellness: https://www.healthmeetswellness.com/
Touch Care Method: https://www.touchcaremethod.com/

📚 Books mentioned:
Seabiscuit - Laura Hillenbrand
The Checklist Manifesto - Atul Gawande

🎲 Also mentioned:
Terraforming Mars (Jakub's favorite board game)

Timestamps:
0:00 Teaser: your energy sets the tone for your entire team — and your patients feel it the moment they walk in
1:50 Scaling Practice Management intro & meet Dr. Elizabeth Edens, Founder & Medical Director at Health Meets Wellness / TouchCare Method
3:36 Icebreaker: what does a perfect Saturday look like for Dr. Edens?
7:04 #1 tip for growing a healthcare practice: why every single moment in the patient experience matters
8:24 Turning wait time into value — how to make delays work for your practice instead of against it
10:25 Start-of-day checklists and the overlooked power of operational preparation
11:48 Building a genuinely cohesive team — why belief in the mission can't be manufactured
15:47 Inside Health Meets Wellness: balancing in-depth 1-on-1 care with high patient demand
18:04 How the Touch Care Method app creates meaningful touchpoints between visits
22:14 Tracking what patients actually eat and do — why data between visits changes the whole conversation
25:28 Driving patient adoption of health tech: removing friction and connecting habits to outcomes
28:33 Will every specialty have its own AI health coach? A look at where digital care is heading
31:34 Build vs. buy: why most practices shouldn't try to build their own patient app from scratch
35:40 Wearables, CGM, and body composition scales — the device stack powering Dr. Edens' practice
38:18 The next frontier in weight management: addressing ultra-processed food at the root
39:45 GLP-1 medications, misinformation, and what patients actually need to know before starting
47:00 Final advice for practice managers: identify your AI pain points and remove admin work first
49:09 Where to find Dr. Edens and the Touch Care Method app

🎥 See how Talkie.ai works - AI medical receptionist demo: https://www.youtube.com/watch?v=oOiJ3ITTrLY&list=PLLjcCBHYN2KoBqm-Dx-8lIwWLuU-CHXSg

Why is the direct primary care (DPC) model gaining so much popularity? And what does it actually take to scale a direct primary care practice - from a single clinic to an 11-location organization with nearly 30 providers?

Dr. Kyle Rickner, co-founder and chairman of Primary Health Partners, joins Jakub Grajcar to share the full story. From the decision to leave the fee-for-service world, to the very real operational challenges of multi-site growth, to what it takes to build a practice genuinely centered on patients instead of billing codes.

We talk about:

💊 Dr. Rickner's #1 tip for growing a sustainable practice - on the importance of planning
🏥 The three core tenets of direct primary care
🔥 "Moral injury" vs. burnout - why the volume-based model doesn't just exhaust physicians, it puts them in conflict with their own oath
🤝 How Primary Health Partners went from two doctors to 11 locations - and the business partners who made it possible
📈 The EOS visionary/integrator dynamic for founders
⚠️ Why the third location is always the hardest - and the stacking complexity that breaks practices trying to grow
🧑‍💼 What to look for in a great operator - and why doctors neglect to ask for this kind of help

👤 Guest: Kyle Rickner, MD
LinkedIn: https://www.linkedin.com/in/kyle-rickner-md-353986111/
Organization - Primary Health Partners: https://primary-healthpartners.com/

📚 Books mentioned:
Who Not How - Dan Sullivan
Traction (EOS) - Gino Wickman

🎥 See how Talkie.ai works - AI medical receptionist demo: https://www.youtube.com/watch?v=oOiJ3ITTrLY&list=PLLjcCBHYN2KoBqm-Dx-8lIwWLuU-CHXSg

Timestamps:
0:00 Teaser: how fee-for-service medicine causes moral injury — and why no DPC doctor ever wants to go back
2:24 Scaling Practice Management intro & meet Dr. Kyle Rickner, Co-Founder and Chairman at Primary Health Partners
3:11 Icebreaker: Dr. Rickner's favorite destination and a Cabo ATV-and-whale-watching adventure
7:12 #1 tip for growing a practice: plan ahead, mitigate risk, and reduce dependence on third-party payers
10:19 The story of a practice that insurance companies literally forced to shut down
12:26 What is direct primary care — and what are its three defining tenets?
14:53 24/7 physician availability in DPC: how it actually works without burning out the doctor
16:58 What physicians love about DPC: escaping the volume treadmill and reclaiming time with patients
20:04 The honest conversation about transitioning to DPC — sacrifice, risk, and the promise of fulfillment
22:33 Moral injury in medicine: how fee-for-service quietly harms both physicians and patients
27:36 How Primary Health Partners grew to 11 locations — and why they're a unicorn in the DPC world
30:04 "Who, not how": bringing in business expertise and funding growth through clinical research revenue
33:06 The EOS framework — visionary vs. integrator — and how it shaped their founding partnership
37:16 Recruiting physicians into DPC and the multi-site operational complexity that kicks in at location #3
40:17 Why they intentionally paused expansion to close operational gaps before the next growth phase
43:40 Why doctors are often the worst at asking for help — and what the ideal ops person looks like
45:59 Where to follow Dr. Rickner and Primary Health Partners